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© 2020 Background: New graduate nurses’ competence is a concern for all healthcare organizations. Previous reports show heterogeneous levels of competency amongst them. As a positive association between competency and quality of care in clinical settings has been suggested, it is essential for researchers and clinicians to select valid, reliable, and responsive scales to assess new nurses’ competence. However, a systematic evaluation of the measurement properties of scales measuring new nurses’ competence had yet to be published. Objective: To analyse, evaluate and synthesize the measurement properties of scales used to assess new nurses’ clinical competence. Design: A systematic psychometric review based on the COnsensus‐based Standards for the selection of health Measurement INstruments (COSMIN) methods. Data sources: The search strategy included a combination of keywords and thesaurus terms related to new graduate nurses, clinical competence, and competence assessment. Five databases were searched: Embase, CINAHL, MEDLINE, PsycINFO and Web of Science. The search was limited to full-text papers published in English or French, from 2010 to 2019. Review methods: Two independent reviewers screened eligible papers, extracted data related to validity, reliability, and responsiveness of each scale, and evaluated the quality of their measurement properties as well as risk of bias in their psychometric evaluation. Divergences were solved through discussion. Results: Ten scales were included: eight original scales, one culturally adapted and one modified. Of these scales, eight were developed or adapted in the 2010s decade and the other two scales were developed earlier. Most scales are divided into 6 to 8 subscales and use an adjectival scale with either 4, 5 or 7 points. The content validity study of all scales in this review was deemed to be doubtful or inadequate quality. Reliability was almost exclusively assessed by calculating the internal consistency with Cronbach's alpha coefficient which gives no information on equivalence or stability of the measure. Responsiveness was never properly assessed in the reviewed studies. Conclusions: There is little evidence on the measurement properties for each scale regarding their validity and reliability; responsiveness was not assessed for any scale. Every scale evaluated in this review had different characteristics (length, subscales, response options). Therefore, selection of the most appropriate scale depends on the context and purpose of the assessment. Prospero registration number: CRD42018109711 TWEETABLE ABSTRACT: Systematic review of scales measuring new nurses’ competence: we must do better and conduct more validity/reliability testing of existing scales.

© 2020 John Wiley & Sons Ltd Aim: To appraise and synthesize evidence of empirical studies reporting assessment of new graduate nurses’ clinical competence in clinical settings. Design: Mixed methods systematic review. Data sources: The search strategy included keywords relevant to: new graduate nurse; clinical competence; and competence assessment. The searched literature databases included CINAHL, MEDLINE, Embase, PsycINFO and Web of Science. The search was limited to full-text papers in English or French, published between 2010 –September 2019. Review Methods: Inclusion criteria were: 1) empirical studies; 2) detailed method and complete results sections; 3) competence assessment in clinical settings; and 4) new graduate nurses (≤24 months). Two independent reviewers screened eligible papers, extracted data and used the Mixed Methods Appraisal Tool framework for quality appraisal. Divergences were solved through discussion. Results: About 42 papers were included in this review: quantitative (N = 31), qualitative (N = 7) and mixed methods (N = 4). Findings suggest that new graduate nurses exhibit a good or adequate level of competence. Longitudinal studies show a significant increase in competence from 0–6 months, but findings are inconsistent from 6-12 months. Conclusion: There are a multitude of quantitative tools available to measure clinical competence. This suggests a need for a review of their rigor. Impact: No recent reviews comprehensively synthesized the findings from new graduate nurses’ clinical competence. This review has found that new graduate nurses’ competence has been mostly assessed as good, despite the expectation that they should be more competent. Longitudinal studies did not always show a significant increase in competence. These findings can help nurse educators in providing more support to new graduate nurses throughout the transition period or design improved transition programme. This review also identified quantitative tools and qualitative methods that can be used for competence assessment.

Dans les 15 dernières années, deux rapports (Frenk et al., 2010; Institute of Medicine, 2003) ont soutenu la nécessité d’une réforme dans les programmes de formation en sciences infirmières et autres sciences de la santé, afin de se baser sur une approche pédagogique par compétences (APC). Ce changement devait permettre de préparer les nouveaux diplômés à la réalité des systèmes de santé et aux défis de l’avenir. Peu d’études ont mis en évidence les compétences mises en œuvre par des infirmiers nouvellement diplômés (IND) de ces programmes réformés. Le but de cette étude était, d’une part, de décrire le déploiement de compétences d’IND d’un programme de baccalauréat basé sur une APC d’une faculté de sciences infirmières (FSI) québécoise, tel que perçu par différents acteurs dans une culture de milieu hospitalier de soins aigus et, d’autre part, de discuter de l’influence de cette culture sur ce déploiement de compétences. Pour guider cette étude, un cadre théorique a été construit, intégrant le modèle de développement de l’expertise professionnelle de Benner (1982, 1984) aux travaux de Tardif (2006) sur l’APC. Une ethnographie ciblée a été réalisée sur trois unités de soins aigus auprès de 19 acteurs-clés, soit des IND (n=4), infirmiers précepteurs (n=2), conseillers en soins infirmiers (n=9) et autres professionnels (n=4). Les données ont été collectées par des entrevues individuelles, groupes de discussion et de l’observation, et analysées selon le cadre ethnographique infirmier de Roper et Shapira (2000). Les résultats ont permis d’identifier trois thèmes. Le premier concerne les débuts professionnels des IND, l’appropriation de leur nouveau rôle, le morcellement de leur pratique en tâches et le développement de leur pratique. Le second thème porte sur la collaboration des IND dans l’équipe interprofessionnelle, la difficulté du travail en dyade avec l’infirmière auxiliaire et leur facilité à maintenir une relation avec les patients et leur famille. Le dernier thème concerne la pratique scientifique des IND, leur curiosité scientifique accrue ainsi que leur utilisation de sources scientifiques et crédibles qui doivent être encouragées. Les éléments décrits dans ces trois thèmes ont été analysés à la lumière du référentiel de compétences pour conclure que les IND déploient sept des huit compétences développées pendant leur formation initiale. Des facteurs organisationnels influencent ce déploiement de compétences, soit le programme d’accueil et d'orientation, la stabilité d’unité et d’horaire, la charge de travail et la culture scientifique de l’unité de soins. Des facteurs individuels ont aussi un impact, soit la personnalité et les stages effectués pendant la formation initiale des IND, l’identification de modèle de rôle, l’intégration des IND à l’équipe et la dénonciation de comportements d’intimidation de la part d’autres infirmières et finalement, la reconnaissance de l’expertise infirmière par les autres professionnels. Les connaissances découlant de cette étude permettent de mieux comprendre la transition d’IND d’un programme basé sur l’APC, lorsqu’ils débutent leur pratique professionnelle. Elles ont des retombées pour les différents champs d’activité de l’exercice infirmier et permettront d’améliorer les programmes de formation initiale et d’adoucir la période de transition entre le milieu de formation et le milieu clinique., In the last 15 years, two important reports (Frenk et al., 2010; Institute of Medicine, 2003) have supported the need for reform in nursing education and other health sciences curricula to build on competency-based education (CBE). This change was intended to prepare new graduates for the reality of health systems and future challenges. Few studies have focused on how newly graduated nurses (NGNs) from these reformed programs use the competencies they have developed. The purpose of this study was twofold: first, to describe the deployment of competencies of NGNs from a competency-based undergraduate nursing program in a Quebec faculty of nursing, as perceived by various actors in acute care settings and second, to examine the influence of the culture of acute care settings on competency deployment by NGNs. To guide this study, a theoretical framework integrating Benner’s professional advancement model (1982) to Tardif’s work on competency-based education and competency development (2006) was built. A focused ethnography was conducted on three acute care units of an academic hospital. Convenience and snowball sampling strategies were used to recruit 19 key actors: NGNs (n = 4), nurse preceptors (n = 2), clinical nurse specialists (n = 9) and other professionals (n = 4). Data were collected through individual interviews, focus groups and observation, and analyzed according to Roper and Shapira (2000) ethnographic nursing analysis framework. Three themes were identified to describe the deployment of competencies of NGNs. The first theme concerns the professional beginnings of NGNs, the appropriation of their new role, the fragmentation of their practice into tasks and the development of their practice. The second theme relates to the collaboration of NGNs in the interprofessional team, their difficulty in the management of the intraprofessional team with licensed practical nurses and their ability to maintain a relationship with patients and families. The last theme concerns the scientific practice of NGNs, their increased scientific curiosity and their use of scientific and credible sources that must be encouraged. The elements described in these three themes were analyzed in the light of the competency framework to conclude that the NGNs deploy seven of the eight competencies developed during their training. Organizational and individual factors were identified as influencing the deployment of competencies of NGNs. Organizational factors are orientation, stability, workload, as well as the scientific culture of the unit. Personal factors have been linked to groups of professionals: for NGNs, personality and clinical placements during their initial training; for nurses working with NGNs, to be role models, to promote integration and to denounce bullying; and for other health professionals, to recognize nursing expertise. The knowledge gained from this study provides a better understanding of the competencies of NGNs and the elements influencing the beginning of their practice. These results have implications for the various fields of nursing practice and will help improve initial training programs and ease the transition period between the academic environment and the clinical setting.